SEC Form 4 · accession 0001140361-16-080219
Health Insurance Innovations, Inc. · HIIQ
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael D Hershberger
Officer — CFO, Secretary and Treasurer
Period of report
Sep 16, 2016
Accepted (ET)
Sep 19, 2016 · 5:32 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001561387
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Class A Common StockF1 | Sep 16, 2016 | A | 9,935 | $0.00 | A | 176,075 | D | |
| Class A Common Stock | Sep 16, 2016 | F | 3,206 | $5.20 | D | 172,869 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Appreciation RIghtsF3 | $5.20 | Sep 16, 2016 | A | 40,972 | A | — | Sep 16, 2023 | Common Stock | 40,972 | 40,972 | D |
| Stock Appreciation RIghtsF3 | $10.45 | holding | — | — | — | — | May 21, 2021 | Common Stock | 25,000 | 25,000 | D |
| Stock Appreciation RIghtsF3 | $4.95 | holding | — | — | — | — | Jul 1, 2022 | Common Stock | 30,000 | 30,000 | D |
| Stock Appreciation RIghtsF3 | $4.99 | holding | — | — | — | — | Sep 16, 2022 | Common Stock | 30,000 | 30,000 | D |
Explanation of responses
- F1These shares of restricted stock were granted under the Issuer's Long-Term Incentive Plan and vest 25% on the first anniversary of grant date, 25% on the second anniversary of grant date, and 50% on the third anniversary of grant date.
- F2Represents withholding of shares by Issuer to satisfy tax liability of Reporting Person incident to vesting of restricted stock.
- F3These stock-settled stock appreciation rights were granted under the Issuer's Long-Term Incentive Plan and vest 50% on the first anniversary of grant date and 50% on the second anniversary of grant date, subject to the terms of the Long-Term Incentive Plan and an award agreement under the Long-Term Incentive Plan.